Perilymphatic fistula(PLF) is an uncommon disease characterized by abnormal leakage of perilymph from the inner ear into the middle ear. Symptoms of PLF include sudden onset hearing loss, tinnitus, ear fullness, and vertigo resulting from inner ear trauma, stapedial surgery or barotrauma such as valsalva, nose blowing. Because nystagmus can be induced by affected ear down position, benign positional paroxysmal vertigo(BPPV) should be considered for differential diagnosis. About 40-50% of the PLF patient has experienced spontaneous healing but surgical repair should be considered when hearing symptom and dizziness was not improved or aggravated within few days. We report on a case of PLF initially misdiagnosed as BPPV but finally successful fistula repair was achieved with a review of the literature.